St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES

Professional

Both

$517.37

Service Code	HCPCS 74713 TC
Min. Negotiated Rate	$388.03
Max. Negotiated Rate	$388.03
Rate for Payer: Cash Price	$138.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$388.03
Rate for Payer: SOMOS Essential	$388.03

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES

Professional

Both

$874.20

Service Code	HCPCS 74713
Min. Negotiated Rate	$655.65
Max. Negotiated Rate	$655.65
Rate for Payer: Cash Price	$234.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$655.65
Rate for Payer: SOMOS Essential	$655.65

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES

Professional

Both

$1,573.29

Service Code	HCPCS 74712
Min. Negotiated Rate	$1,179.97
Max. Negotiated Rate	$1,179.97
Rate for Payer: Cash Price	$486.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,179.97
Rate for Payer: SOMOS Essential	$1,179.97

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES

Professional

Both

$994.32

Service Code	HCPCS 74712 TC
Min. Negotiated Rate	$745.74
Max. Negotiated Rate	$745.74
Rate for Payer: Cash Price	$329.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$745.74
Rate for Payer: SOMOS Essential	$745.74

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES

Professional

Both

$578.94

Service Code	HCPCS 74712 26
Min. Negotiated Rate	$434.20
Max. Negotiated Rate	$434.20
Rate for Payer: Cash Price	$156.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$434.20
Rate for Payer: SOMOS Essential	$434.20

CHG FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR

Professional

Both

$141.09

Service Code	HCPCS 85390 26
Min. Negotiated Rate	$105.82
Max. Negotiated Rate	$105.82
Rate for Payer: Cash Price	$38.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.82
Rate for Payer: SOMOS Essential	$105.82

CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS

Professional

Both

$529.87

Service Code	HCPCS 88182 TC
Min. Negotiated Rate	$397.40
Max. Negotiated Rate	$397.40
Rate for Payer: Cash Price	$154.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$397.40
Rate for Payer: SOMOS Essential	$397.40

CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS

Professional

Both

$679.39

Service Code	HCPCS 88182
Min. Negotiated Rate	$509.54
Max. Negotiated Rate	$509.54
Rate for Payer: Cash Price	$194.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$509.54
Rate for Payer: SOMOS Essential	$509.54

CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS

Professional

Both

$149.49

Service Code	HCPCS 88182 26
Min. Negotiated Rate	$112.12
Max. Negotiated Rate	$112.12
Rate for Payer: Cash Price	$40.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$112.12
Rate for Payer: SOMOS Essential	$112.12

CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST

Professional

Both

$321.72

Service Code	HCPCS 88184
Min. Negotiated Rate	$241.29
Max. Negotiated Rate	$241.29
Rate for Payer: Cash Price	$92.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.29
Rate for Payer: SOMOS Essential	$241.29

CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA

Professional

Both

$102.06

Service Code	HCPCS 88185
Min. Negotiated Rate	$76.54
Max. Negotiated Rate	$76.54
Rate for Payer: Cash Price	$27.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.54
Rate for Payer: SOMOS Essential	$76.54

CHG FLOW CYTOMETRY INTERPJ 2-8 MARKERS

Professional

Both

$141.02

Service Code	HCPCS 88187
Min. Negotiated Rate	$105.76
Max. Negotiated Rate	$105.76
Rate for Payer: Cash Price	$38.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.76
Rate for Payer: SOMOS Essential	$105.76

CHG FLOW CYTOMETRY INTERPJ 9-15 MARKERS

Professional

Both

$247.21

Service Code	HCPCS 88188
Min. Negotiated Rate	$185.41
Max. Negotiated Rate	$185.41
Rate for Payer: Cash Price	$67.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$185.41
Rate for Payer: SOMOS Essential	$185.41

CHG FLOW CYTOMETRY INTERPRETATION 16/> MARKERS

Professional

Both

$332.57

Service Code	HCPCS 88189
Min. Negotiated Rate	$249.43
Max. Negotiated Rate	$249.43
Rate for Payer: Cash Price	$90.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$249.43
Rate for Payer: SOMOS Essential	$249.43

CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY

Professional

Both

$69.20

Service Code	HCPCS 86255 26
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Cash Price	$19.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.90
Rate for Payer: SOMOS Essential	$51.90

CHG FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY

Professional

Both

$69.20

Service Code	HCPCS 86256 26
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Cash Price	$19.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.90
Rate for Payer: SOMOS Essential	$51.90

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

Professional

Both

$116.27

Service Code	HCPCS 77003 26
Min. Negotiated Rate	$87.20
Max. Negotiated Rate	$87.20
Rate for Payer: Cash Price	$31.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87.20
Rate for Payer: SOMOS Essential	$87.20

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

Professional

Both

$336.25

Service Code	HCPCS 77003 TC
Min. Negotiated Rate	$252.19
Max. Negotiated Rate	$252.19
Rate for Payer: Cash Price	$91.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$252.19
Rate for Payer: SOMOS Essential	$252.19

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

Professional

Both

$452.52

Service Code	HCPCS 77003
Min. Negotiated Rate	$339.39
Max. Negotiated Rate	$339.39
Rate for Payer: Cash Price	$122.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$339.39
Rate for Payer: SOMOS Essential	$339.39

CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT

Professional

Both

$74.34

Service Code	HCPCS 77001 26
Min. Negotiated Rate	$55.76
Max. Negotiated Rate	$55.76
Rate for Payer: Cash Price	$20.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.76
Rate for Payer: SOMOS Essential	$55.76

CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT

Professional

Both

$359.24

Service Code	HCPCS 77001 TC
Min. Negotiated Rate	$269.43
Max. Negotiated Rate	$269.43
Rate for Payer: Cash Price	$95.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$269.43
Rate for Payer: SOMOS Essential	$269.43

CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT

Professional

Both

$433.58

Service Code	HCPCS 77001
Min. Negotiated Rate	$325.18
Max. Negotiated Rate	$325.18
Rate for Payer: Cash Price	$115.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$325.18
Rate for Payer: SOMOS Essential	$325.18

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$499.63

Service Code	HCPCS 77002
Min. Negotiated Rate	$374.72
Max. Negotiated Rate	$374.72
Rate for Payer: Cash Price	$135.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$374.72
Rate for Payer: SOMOS Essential	$374.72

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$110.22

Service Code	HCPCS 77002 26
Min. Negotiated Rate	$82.66
Max. Negotiated Rate	$82.66
Rate for Payer: Cash Price	$29.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82.66
Rate for Payer: SOMOS Essential	$82.66

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$389.41

Service Code	HCPCS 77002 TC
Min. Negotiated Rate	$292.06
Max. Negotiated Rate	$292.06
Rate for Payer: Cash Price	$105.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$292.06
Rate for Payer: SOMOS Essential	$292.06

Know your out-of-pocket cost for care.

All Charges